You only die once

Chapter 1 You only die once

Chapter 1

You only die once

It was 18th January. It was supposed to be a very busy Monday morning with many patients to see. Instead, I was in another hospital 15 kilometres away awaiting the doctors.

It has been a rather anxious 20 hours. I have been fasting for the last few hours, only being able to have a few biscuits at 5 am with some sips of water.

The doors of the High Dependency Unit (HDU) opened but it was not my doctor. Some other doctor to the next patient. I had been half-asleep for the last 10 hours or so. Waking up and feeling the uncomfortable bed with a ripple mattress with ECG leads attached to me. Usually, there are three or four leads but here they used five instead. The oximeter remained on my right index finger. The blood pressure cuff was on my left arm. I was well and truly hooked up. Wasn't easy even to sit up. In my state, I could hear some discussions about the next patient. The night before, he had gotten worse and was wheeled to the next bed. There was a bit of commotion and then after a few hours, it settled. Come this morning, the activity was hived around him. They brought up the X-ray machine, repeated the ECG, and did more blood tests before the doctors came again. They planned for an urgent CT scan. Then the HDU quietened down again.

At that moment, I became more anxious. Nothing much to focus on. My thoughts drifted to the past and recent present. "Am I gonna get well from all this?" Flashes of my patients and the times I spoke to them and their relatives came flooding back. Some made it and some did not. Flashes of happy memories of patients who had beaten the odds and also the grief of the families of those who did not.

The HDU door opened and a friendly face appeared. Ms Laysi appeared with her usual positive attitude and a big smile.

I greeted her with, "So nice to see you. We have not met for at least 10 years now. You are just the same as before."

"What happen to you? Matron Yen told me you got admitted yesterday and I said I must come and see you first thing today," she greeted me.

"The same again as six months ago. I felt weak on my left side and here I am. Now I feel normal. It was just for about 20 to 30 minutes. A bit scary though."

"I hear as much. Dr Wern will be here shortly. You slept well last night?"

"I sort of did. Sleep, wake, sleep. With the saline drip, keep waking up to pee. Haha."

She said jokingly, "I bet you cannot remember my name," while covering her name tag.

"Laysi. Of course I remember," I said. Well, I think I would have but the day before, my doctor who referred me already mentioned her name and that she was one of the matrons in this hospital. So I had forewarning.

We chatted a bit more till Dr Sean arrived. It was now 10 am. I could not help myself watching the time every few minutes. Time seemed to pass slowly this morning.

Dr Sean, an intervention radiologist, is well known for his skills and that was one of the reasons I was transferred over. He is competent in his work. He wore a slim figure that I would certainly admire. Like me, 20 years ago when I weighed 57 kg. Now I am 81kg. 😞😔☹️

The usual greetings were exchanged. I had only met him once or twice in the past. May have spoken on the phone a few more times. This time I was the patient and not the doctor.

"Have you have seen your scan we did yesterday?" he asked.

"No, I have not. It was not shown to me," I said.

A short flashback of the night before. 🤔 Hmmm. The nurse the night before was a bit less forthcoming. I had finally called Dr Wern, my neurologist, late in the night after waiting for three hours. He informed me that the scan showed that there was a narrowing in an artery and a procedure was needed. He would come and talk to me in the morning. Dr Sean and him had discussed my problem. I had guessed as much already. Being a doctor is at times not an advantage when you know too much. Only makes you anticipate and fear for the worst possible.

Next thing, I was staring at the monitor seeing my scan. Dr Sean showed me the abrupt narrowing at my left vertebral artery leaving less than 10% of the lumen patent. For some funny reason, my left artery was like three times the size of the right. So it was the dominant artery. The brain's blood flow is mainly supplied by four arteries. My two carotid arteries were normal in size. These four arteries converge together in a sort of roundabout of arteries called the circle of Willis. If one is blocked, the other three can continue to supply sufficient blood to all parts of the brain. At most times, this 'guarantee' works but in my case, the circle of Wills seemed less developed and the posterior communicating arteries were small. Both my doctors felt that there may not be enough supply; if the problematic left vertebral artery was totally blocked, I would have a full-blown stroke. The symptoms I had the day before was that of a transient ischaemic attack. Blood supply to my brainstem area was impaired for a short while. I did not have a real stroke.

They proposed to have a stent inserted that morning. As we were discussing the scan, Dr Wern appeared and joined the conversation.

For the first time in my life, I was required to make a life and death decision. Although they mentioned there are possible risks, obviously they played down the most serious complication.

I said, "I don't really have a choice. Six months and it has not gotten any better. If it blocks completely, then I really would have a stroke. And because it seems to be the main supply to the brainstem, I may be screwed (die). Let's get it done. I am already fasting."

And so, the decision was made. They were almost ready. I signed the consent form. My wife and some close friends were around. Everyone seemed cheerful. Like I am gonna be playing for Arsenal now. It felt like pre-match euphoria. But it wasn't actually. Everyone wanted to cheer me on, like wanting me to score the winning goal. Ha.

Instead, I knew the odds. No doubt that success was more likely than failure. But, like the football club I have grown fond of, winning is never guaranteed even if all bets are on your side. Seeing the words 'coma' and 'death' as complications listed on the consent form brought a sense of reality. Ahh well. Gotta take my own advice that I give my patients: "Hope for the best, prepare for the worst." With that thought, I called out to Dr Wern to come over. My wife, close friends, and Laysi were beside me.

"If things go wrong and I am in coma or vegetative state, I want it turned off," I said, indicating with my right hand the way I would switch off a machine. In my mind, it was simple. You live. Then you die. When the time comes, just die.

Everyone around was stunned. Dr Wern said, "It is not always like that. Patients have recovered even if they stroked."

"I understand but you know what I mean. When there is no chance or only a minuscule chance of recovery, turn it off."

He nodded his head and asked me if I wanted to sign a document.

"Nay. No need. All present here bear witness. This is more important. No need to sign." And with that I made a lot of people cry. Consent can be signed but if the next of kin don't agree, doctors always have a difficult problem.

Within minutes I was wheeled into the catheterisation lab. The anaesthetist greeted me and he briefly pulled down his mask for me to recognise him. As fate would have it, he was my housemate 25 years ago when we worked in another city. A face mask was held to my face and I was asked to breathe in and out slowly. I was given a white colour injection, most likely Propofol (the same stuff MJ got...). It really stung. I was asked to breathe and count. I knew I was breathing in oxygen and would pass out soon from the anaesthetic. In a moment, I was unconscious.

Do we know when our time is near or has come? Do we want to know? How do we prepare? Can we prepare?

Reference:

https://en.wikipedia.org/wiki/Circle_of_Willis